Justice in Aging Blog

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Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources.

Today as part of an ongoing attack on the most marginalized, the Trump Administration is proposing dangerous and far reaching changes to regulations implementing the Health Care Rights Law, Section 1557 of the Affordable Care Act, which prohibits discrimination in healthcare. The proposal attempts to eliminate the rights of LGBTQ people. It also rolls back protections for limited English proficient (LEP) older adults, and attempts to radically limit the way that victims of any type of discrimination can seek redress under the law. By gutting the only federal law designed to protect against discrimination in health care, the move is a cruel, extremist, and transparent political attack on LGBTQ older adults, LEP seniors, and others who frequently face discrimination in accessing care.

The ACA’s Health Care Rights provision is a landmark civil rights law that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in federal health programs and activities. The law includes affirmative protections for consumers and obligations on insurers and providers, as well as a new avenue for older adults and others to enforce their rights.

The proposed changes to the Health Care Rights Law will be particularly harmful for transgender older adults – one in five of whom report being refused care because of their gender status. This discrimination, which compounds over a lifetime, contributes to poorer health outcomes among transgender older adults, with one in three reporting poor physical health. By deleting references to protections based on gender identity, sexual orientation, and sex stereotyping across federal healthcare regulations, the Trump Administration’s proposal is saying transgender older adults and LGBTQ people more broadly do not have the right to receive the care they need and be treated with dignity.

In the same proposed rulemaking, the Trump Administration is also rolling back language access protections for LEP older adults by eliminating the requirement that healthcare providers affirmatively distribute notices of non-discrimination and include translated taglines in significant communications to consumers. These requirements, key to enforcing Title VI of the Civil Rights Act, are critical to assist LEP communities to better understand their rights and access care.

Finally, if gutting key provisions of the existing regulations were not enough, the proposed rulemaking takes aim at the Health Care Rights Law’s enforcement structure, which would make it significantly more difficult to bring particular discrimination claims under the law.

To be clear, this proposed rule is part of a larger, strategic attack on the lives of LGBTQ and LEP older adults. The Department of Health and Human Services Office for Civil Rights (OCR), the same agency tasked with enforcing Section 1557, recently released a final “Conscience Rights” rule that allows providers to discriminate against transgender older adults and others on religious and moral grounds and changed the OCR mission statement to emphasize conscience and religious freedom. Meanwhile, the Department of Homeland Security’s proposed “public charge” rule would make it nearly impossible for LEP older immigrants to enter the U.S. or become permanent residents if they are not wealthy and use or might need Medicaid or help paying for Medicare, food or housing.

Upon the proposed rule being published in the Federal Register, a 60-day public comment period will begin. In the coming weeks, Justice in Aging will provide resources, including template comments, to help advocates fight back. Now is the time to tell the Trump Administration that the lives, rights, and dignity of LGBTQ older adults, LEP seniors, and people with disabilities matter and to protect the Health Care Rights Law.

In January, Governor Newsom called for a Master Plan on Aging in his State of the State address, and concurrently members of the legislature introduced several bills aimed at addressing California’s growing aging population. The need is urgent as California’s population ages and grows poorer. California’s population of older adults is expected to almost double over the next twenty years. Today, one in five seniors in California live at or below the poverty level, with women and populations of color experiencing poverty at higher rates. Without a dedicated plan and resources to address California’s aging population, many more older adults will fall into poverty in their later years.

As lawmakers work to revise the 2020 budget this month, we urge them to direct funding toward a comprehensive Master Plan that addresses the struggles of the poorest Californians, is centered on equity, makes provision for a robust long-term care system, and is both intergenerational and intersectional.

We laid out a set of principles that we urge policymakers to consider and incorporate in the Master Plan to help those Californians who are struggling the most, and also middle class older adults, families, and all of our communities. We have the political momentum to address the needs of California’s aging population. This is a once-in-a-generation opportunity to get it right and help all Californians age in dignity and justice.

Non-Emergency Medical Transportation (NEMT) is a federally required Medicaid benefit. Within certain guidelines, each state Medicaid program is given significant discretion in crafting the NEMT benefit for Medicaid beneficiaries. This important program currently serves over 7 million Medicaid enrollees who, due to cognitive and physical changes, may have a reduced ability to drive or use public transportation. It is now under threat.

The Centers for Medicare and Medicaid Services (CMS) has signaled that it will propose a regulation in May 2019 to make the mandatory NEMT benefit optional for states. States could then choose to amend their Medicaid rules to eliminate or reduce the benefit.

A new Justice in Aging fact sheet provides advocates with information about why NEMT is important, how it is administered, and the current threat to this vital benefit, as well as information on where to go for more information and advocacy tips for preserving the NEMT benefit in their states.

Justice in Aging is working in coalition with partners like Community Catalyst to raise awareness about the importance of Medicaid transportation to ensure it remains a covered benefit.

Many seniors in Vermont who suffer from dementia are waiting months, and some up to a year, in hospitals before being accepted into nursing homes. Seniors affected by long wait times also tend to qualify for Medicaid and have health conditions that call for higher staffing needs. Justice in Aging’s Directing Attorney Eric Carlson said that the state’s nursing home waits are “atypical.” And that “the level of difficulty that you’re talking about in Vermont is far above what I think the average is.” Advocates recommend increasing Medicaid’s nursing home reimbursement rate and creating specialized dementia facilities.

The Centers for Medicare and Medicaid Services (CMS) recently finalized rules implementing regulations governing minimum integration standards for Dual Eligible Special Needs Plans (D-SNPs) pursuant to the Bipartisan Budget Act of 2018. D-SNPs are Medicare Advantage plans that limit enrollment to individuals who are dually eligible for Medicare and Medicaid. With the permanent authorization of D-SNPs, we expect to see an increase of D-SNPs entering the market across the country.

Justice in Aging has analyzed the new regulations and created a new factsheet summarizing the major integration requirements including special considerations for advocates.

Due in part to advocacy from groups like Californians for SSI, the 2018-2019 state budget included a policy change allowing California seniors and people with disabilities who receive SSI to be eligible for CalFresh (SNAP) benefits starting June 1, 2019.

Access to federal SNAP nutrition assistance will increase food security for California’s low-income SSI seniors and people with disabilities, leading to fewer people being forced to choose between basics like food and medicine, and giving people more flexibility to direct money toward other needs such as finding and being able to afford housing. The expansion will be particularly important for seniors age 60 or older, who represent more than half of the over 1.2 million low-income Californians who receive SSI to help meet their basic needs.

Aging services providers can learn more details about this important and historic change in a new fact sheet from Justice in Aging. The five-page fact sheet helps providers understand the details of the change in order to better support their clients. The fact sheet also includes information on CalFresh rules that will be particularly relevant for enrolling SSI seniors and people with disabilities this summer and beyond.

Accessing the Medicare program as an older immigrant can be a complex and confusing process – especially when an immigrant is not a citizen, has limited work history, and limited English proficiency. Justice in Aging’s new issue brief, Older Immigrants and Medicare, is intended to provide advocates who work with older immigrants a summary of the policies and practices to help immigrants enroll in and pay for Medicare coverage.

The issue brief specifically covers the following topics and includes numerous hypothetical examples to illustrate the myriad of rules and scenarios older immigrants face when attempting to access Medicare:

Eligibility and enrollment, with particular attention to rules affecting non-citizens

Join us for a discussion of California budget and legislative proposals this year that could make concrete improvements to the economic security and health care of low-income older adults. This webinar, California Legislative and Budget Proposals that Affect Low-Income Older Adults, provides an overview of a number of key proposals, and offers advocates information on how they can engage in the process.

One package of bills has been introduced that would work together to make Medi-Cal more fair and equitable and create more stability for seniors and people with disabilities. You can read about those bills here. Justice in Aging will be releasing additional materials on 2019 California legislative proposals and their impact on older adults soon.

Who Should Participate:

Aging and legal advocates, community-based providers, local government partners, and others wanting to learn more about economic security and health care proposals that impact low-income older adults.

Join us for a discussion of California budget and legislative proposals this year that could make concrete improvements to the economic security and health care of low-income older adults. This webinar, California Legislative and Budget Proposals that Affect Low-Income Older Adults, provides an overview of a number of key proposals, and offers advocates information on how they can engage in the process.

One package of bills has been introduced that would work together to make Medi-Cal more fair and equitable and create more stability for seniors and people with disabilities. You can read about those bills here. Justice in Aging will be releasing additional materials on 2019 California legislative proposals and their impact on older adults soon.

Who Should Participate:

Aging and legal advocates, community-based providers, local government partners, and others wanting to learn more about economic security and health care proposals that impact low-income older adults.

The state of California has introduced three bills meant to help low-income seniors relying on Medi-Cal to cover health care costs. If passed, seniors over age 65 and people with disabilities would qualify for free coverage.

“Obamacare expanded coverage and affordability provisions for low-income people, but many of those benefits don’t apply to seniors once they reach age 65”, said Justice in Aging’s Senior Staff Attorney Claire Ramsey. “It’s about making Medi-Cal fairer and work better for older adults. We’re trying to stabilize their income and their financial security.” This article is behind a paywall. This is a summary.